Intermittent fasting associated with increased risk of early death
jandonline.org
jandonline.org
Like, one obvious reason people skip meals is that they don't have time. If you don't have time to eat, you're probably working long hours and really stressed out. Stress could easily contribute to CVD or otherwise take years off your life.
Another obvious reason to skip meals: you don't have money to buy food. Poverty is well known to lead to worse health outcomes.
Or one more: people skip meals because they have no appetite. What's a big cohort that routinely skips meals because they have no appetite? The elderly.
Maybe they ruled these kinds of things out in the full paper (I've only read the abstract) but so far I'm unimpressed.
> As shown in Table 1, compared with participants with three meals per day, participants eating fewer than three meals per day were more likely to be younger, men, non-Hispanic Black, with less education and lower family income, current smokers, heavy alcohol drinkers, higher physical activity levels, lower total energy intake and lower diet quality, food insecure, and higher frequency of snacks.
They control for these factors in the statistical analysis, to different extents in three different models:
> Model 1 adjusted for age, gender, and race and ethnicity. Model 2 additionally adjusted for education, income, smoking status, alcohol intake, physical activity levels, total energy intake, HEI-2010 score, household adult food insecurity status, and snacks frequency. Model 3 further adjusted for baseline diabetes, hypertension, hypercholesterolemia, CVD, cancer, and BMI status, because these variables may be mediators between meal frequency, intervals and timing, and mortality.
This is an issue. Controlling for the variables in the model helps somewhat, but it's inevitable that the populations are also different in other relevant ways that are not captured in the covariates (e.g. stress levels).
They're also reporting dozens of results (18 in Table 2, another 18 in Table 3, 12 in Table 4) but doing no correction for multiple testing. Given that many of the confidence intervals only barely exclude 1, this is an issue.
Finally, and most damning--the effects almost entirely disappear if they exclude people who had cancer or cardiovascular disease at the beginning of the study. This is hidden in the supplementary material of the paper, not discussed at all within the main body of the paper. Of the effects cited in the abstract the only one that survives excluding people who had cancer or cardiovascular disease at baseline is that people who skip breakfast appear to have higher risk of cardiovascular disease-related mortality.
Given that the study is labelled "prospective" and one of the outcomes studied is death from cardiovascular disease, IMO it is dishonest to not note that the claimed effects disappear if you exclude people who already had cardiovascular disease when the study started.
I'd bet this behavior it correlates with late-night eating.
This doesn't pass the smell test.
In my limited personal experience, it's not obese people i see doing intermittent fasting - it's more like the keto crowd.
the multivariable-adjusted HRs for participants
There are so many variables in these things, that it’s damn near impossible to do truly neutral studies; especially if there’s any money to be made.
https://en.wikipedia.org/wiki/Academy_of_Nutrition_and_Diete...
The organization also publishes nutrition facts sheets for the general public, which food companies pay $20,000 to take part in writing the documents.[77] A list of these publications for the general public include:
What's a Mom to Do: Healthy Eating Tips for Families sponsored by Wendy's.[78]
Lamb: The Essence of Nutrient Rich Flavor sponsored by the Tri-Lamb Group.[79]
Cocoa and Chocolate: Sweet News! sponsored by the Hershey Center for Health and Nutrition.[80]
Eggs: A Good Choice for Moms-to-Be sponsored by the American Egg Board.[81]
Adult Beverage Consumption: Making Responsible Drinking Choices sponsored by the Distilled Spirits Council.[82]
This industry funding also gives food companies the ability to offer official educational seminars to teach dietitians how to advise their clients in a way that advances the interests of the food company. For instance, in a Coca-Cola sponsored seminar for dietitians, the speaker promoted free sugars consumption for children as a healthy choice.[83]"And what about obese people eating three big meals a day?
I feel great when I stop eating by 2 PM. Sleep better, have more vivid dreams, and more energy the next day.
I'm reminded of an old doctor approaching retirement who told me longevity was largely luck and genetics.
But what they don't say is people who didn't take the drug but avoided obesity and excess Alcohol, Drugs, Tobacco had a 70% better outcome.
Every time I’ve had a (luckily mild!) issue they’ve suggested lifestyle changes.
Half of the comments making assumptions that you can not make on the data provided, the other half seems to be IF Crusaders trying to justify their own "healthy" eating behavior as if their life depends on it.
Here is a very simple thing to do when you don't understand a paper or how to interpret it. Send the Authors a mail and ask politely if they could help you understand their work better. There are multiple E-Mail Addresses provided from the Authors.
Seriously "I feel great when I stop eating by 2 PM" is a fun comment, but feeling great and being healthy are not exactly correlated.
I climbed Everest once and my body started dying at about 26000 feet, it felt amazing, still I was literally dying.
Maybe I should just take a break from reading HN comments, it's not like it used to be.
...
> Here is a very simple thing to do when you don't understand a paper or how to interpret it. Send the Authors a mail and ask politely if they could help you understand their work better. There are multiple E-Mail Addresses provided from the Authors.
So, just so I'm clear: You're complaining that people didn't email the study authors and interrogate their work before commenting on the article here?
Everyone should feel free to express themselves and I always encourage people to contribute. I'd just appreciate if people spent more time thinking about if they actually have something to say that has any sort of value for me as a reader on the topic in return for the time I'm giving them to read their submission / comments, as a basic form of respect.
In my opinion the steady decline of quality in comments and submissions, especially on scientific submissions posted here, is because a growing amount of people are not doing the minimal amount of research it takes to form an educated opinion about a topic.
But getting the science wrong has very real consequences. For example, when a community doesn’t vaccinate children because they’re afraid of “toxins” and think that prayer (or diet, exercise, and “clean living”) is enough to prevent infection, outbreaks happen.
To form a truly educated opinion on a scientific subject, you need to become familiar with current research in that field. And to do that, you have to read the primary research literature.
Reading and understanding research papers is a skill which every single doctor and scientist has had to learn during graduate school. Everyone can learn it, but like any skill it takes patience and practice.
Based on what I read in the comments for this submission, a lot of people do not want or can not spend that time on building an educated opinion on the topic and figuring out if the underlying paper has scientific authority.
That's why I encouraged them to ask the Authors directly, if something is unclear or they are making assumptions that are simply not supported by the paper.
I'd still appreciate if more people learned how to read and interpret scientific work but in a world where most people want instant rewards and have a rather short attention span, a short, polite E-Mail to the Authors is a shortcut to gain valuable insight on the scientific work and your own assumptions about it, so that you don't sound like a complete idiot to people who have actual knowledge about the topic when you say things like "Most people in this study were probably obese and would have died anyway" or "Probably junkies skipping meals".
I could take time to explain this paper in an even lengthier comment, but I'm just Jamesbeam on HN. You have no idea if I'm a nobel prize winner or maybe having an agenda to persuade you into a certain direction, but the authors of this paper are actually scientists published in a reputable journal and they were so kind to even give you the ability to contact them by publishing their E-Mails.
And yes, I think it's a good idea to challenge your assumptions by asking people with actual knowledge about the topic so you don't look like a complete fool on the Internet.
A study gets posted to Hacker News.
You seem to expect every single person who wishes to discuss the study to first become an expert in the subject matter ("To form a truly educated opinion on a scientific subject, you need to become familiar with current research in that field.") and deeply engage with the material at the level of, if not an expert, at least a dedicated amateur ("That's why I encouraged them to ask the Authors directly, if something is unclear or they are making assumptions that are simply not supported by the paper.").
You're basing this all on a claim that HN comments have reduced in quality ("In my opinion the steady decline of quality in comments and submissions...") which is rooted in nothing more than your own personal opinion (which is a bit ironic for someone insisting that everyone do a deep and fundamental analysis of a topic before they weigh in on it) and, frankly, a fairly self-centered view of what dialog should look like here ("I'd just appreciate if people spent more time thinking about if they actually have something to say that has any sort of value for *me*").
Bluntly, this just looks like gatekeeping and elitism to me.
Yes, I agree, folks should read the articles or studies before commenting. No question there. That's just basic due diligence.
But this is a discussion forum first and foremost, and some of the very best interactions I've seen, here, have been between interested amateurs either asking questions or posing theories, and experts coming along and chiming in.
Weirdly, you seem to recognize the value in that ("And yes, I think it's a good idea to challenge your assumptions by asking people with actual knowledge about the topic so you don't look like a complete fool on the Internet.") You apparently just don't want people using this forum to engage in those conversations, which is really very strange to me.
If you don't want that kind of interaction, maybe you should continue to dial down your interactions with HN, because it seems to me this community is not what you want or need (which appears to be a group of only subject matter experts weighing in on any given topic).
Like I said in my original comment and you coming to the same conclusion, maybe after eight years of reading daily and interacting whenever I had something to say on HN it's time to dial down my overall interactions with HN and look for a different kind of community.
People change, and so do communities. Maybe it's time to move on.
It's not saying anything about 3 meals vs. any other number of meals.
The lowest hazard rate/lowest all-cause mortality was among those who ate 3 meals a day and had 4.5+ hours between them.
In addition, we need to know what percentage of the people were doing fasting, in order to determine if the HRs are statistically significant. That claim a 95% confidence ratio, but is that true?
If we're not able to do this kind of simple checkup on the data, we will just confuse us even more when we find another paper that adds even more naunce and complexity to the issue. That's how people become anti-science. Because we don't understand /this/ work, this work causes us cognitive dissonance. And because we don't understand this work, our dissonance is even worse next time.
I hope a kind statistician comes along and help our thread about by explaining the numbers and what they really mean in terms of death risk and life expectancy.
This I agree with. There is so much noise and so many confounding factors affecting the underlying data that you are bound to frequently get conflicting results. Compound this with the fact that studies with the most surprising (read: contrarian) results tend to get the most press, and you get an infinite see-saw in the literature.
> Am I wrong to have suspicions about the possibility that food conglomerates may have funded this study?
This I don't agree with. I think your model of more fasting equals less spending on food is overly simplicitic. The sort of health conscious people who are interested in IF tend to be wealthy and willing to spend on premium health related products. I'd wager that you can make a lot more money selling a few premium, organic, protein bars that you pitch as premium feel-full-for-12-hour-guaranteed products than you can by selling the same old breakfast cereals.
Besides, Occam's razor. Intermittent fasting is not a subject where there is or ever has been an overwhelming consensus in the literature, as opposed to say, climate science. It's not surprising or suspicious in the least to see a contrarian result in this field.
IF wasn't a mainstream practice then - meaning that the bulk of people who try to eat healthy may have been targeting more meals in that period than recent years.
Just a possible hypothesis.
But the basic idea is that in the samples under the two different conditions, the ratio of the observed frequencies is 1.3 or 1.8. E.g. it'd be 1.8 if in the fasting sample they saw 3.6% bad outcome, while in the nonfasting sample they saw 2.0% bad outcome.
Since the risk is low already, an individual might be indifferent to a 1% or 2% death rate - from an individual perspective the two are even statistically indistinguishable (they can't exactly die more than once!)
Okay, I'm a little less freaked out by the seeming /doubling/ of death rate, however, it's still 2x increase in death rate. Still chilling!
Now I suppose that if we assume the death rate is constant for everyone at all times - or use a more realistic actuarial curve - then we can even transform the HR factor into an average effect on lifespan for fasters vs nonfaster.
Then we could say "ah, nonfasters will die on average 4 years sooner than nonfasters". I think that would help contextualize the numbers even better than relative death rates (which are hard for individuals to reason about).
Are you familiar with how we might convert death HR into an expected lifespan delta for the average person? Would that analysis actually hold any meaningful truth?
You'd have to integrate over lifespan using an actuarial table, I assume.
This figure of 1.8 wasn't for all-cause mortality, but rather for heart-disease deaths among breakfast-skippers. I wouldn't worry (much) for a bunch of related reasons:
- The more complexity you need to specify a statistic, the more evidence you need to overcome a presumption it's an artifact. (Some of this caveat shows up in how they report it ("multivariable-adjusted", "95% confidence interval"), but these frequentist-statistics methods don't really account for all the real-world reasons for doubt.)
- This study was observational, not interventional. It's one study. Observational studies, particularly in epidemiology, particularly for diet, are often misleading.
- What'd be the mechanism making skipping breakfast have this big an effect? There could well be a good answer to that, but it doesn't spring to mind for me. In other words, what was your prior on this hypothesis, before this paper?
- I haven't read the paper beyond the abstract linked to, but https://news.ycombinator.com/item?id=34883541 lists some potential problems.
- The process that brings a particular medical paper to your attention, unfortunately, is not much like one that optimizes for the most significant updates to the probability distribution you should have over hypotheses. Unless you have a much better news feed than most of us, anyway.
I think of a result like this as a little bit of evidence to keep in mind as you learn more. It's not making me do anything different right now. That might seem harsh about a study involving "185,398 person-years of follow-up period" -- that must've taken a fuck-ton of work -- but it seems to be the world we're in.
Similarly, avoiding or ceasing of habitual smoking of cigarettes has ample evidence for lifespan improvement.
Colloquially all of that is a lot easier to state.
This post should be flagged/removed.
There are many intermittent fasting protocols including multi-day fasts which have been shown to prolong life in mice. But daily fasting is included in those protocols.
A lot of health hype has focused on Daily Time-Restricted feedings. This kind of IF is typically characterized by a daily meal period of 8 hours or less, with only water or snacks under 50 calories allowed during the rest of the time.
This is supposed to promote changes like reducing insulin resistance, but there are questions about the hype vs truth of this.
> ...snacks under 50 calories allowed during the rest of the time.
This is not fasting. Even just 20 calories is generally expected to stop the fast. 50 calories would definitely stop the fast.
I caution you that you are using a nonstandard definition of fasting that does not include all the currently recognized forms of intermittent fasting. Nor have you presented a definition of intermittent fasting - it's likely your definition is too narrow to cover the current practices.
I refer you once more to the wikiepdia article on IF (which leads . Again, the relevant term is "Daily Restricted Feeding". That information is here:
https://en.wikipedia.org/wiki/Intermittent_fasting
It's entirely fair to regard the current research as having to do with Daily Restricted Feeding, which is a form of IF.
And yes, the article does not mention snacking. I was simply claiming that some IF protocls even allow light snacks, to help persuade you that IF protocols are more diverse that you think.
The goal of these protocols is to reduce things like insulin resistance, which happens when the body is in a physiologically fasted state. Some nutritionists claim a snack under 50 cals won't compromise the outcomes, supposedly because the 50 cals is too small to physiologically break the fast.
This is informally called the "50 calorie rule", and it's relevant because the IF community and nutritionists sometimes endorse it. The point was to communicate that there is a variety of IF protocols beyond what you recognize as fasting.
I will say that it's frustrating for me that you dispute well known concepts and trends in the nutrition community - at least acknowledge what I am saying, and give counter arguments if you disagree. If you can't, I will conclude your motivation here has to do with something other than seeking the truth about our state of understanding of IF. If that's the case, lets end the convo.
yawn .. next.